Provider Demographics
NPI:1659567527
Name:PERRY COUNTY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PERRY COUNTY MEDICAL CENTER, INC.
Other - Org Name:THREE RIVERS COMMUNITY HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-589-2104
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-0129
Mailing Address - Country:US
Mailing Address - Phone:931-670-5520
Mailing Address - Fax:931-670-5312
Practice Address - Street 1:7723 CLEARVIEW CHURCH LN
Practice Address - Street 2:
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-1609
Practice Address - Country:US
Practice Address - Phone:931-670-5520
Practice Address - Fax:931-670-5312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY COUNTY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)